HomeMy WebLinkAbout502 S Lincoln St - Building
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DNISION
321 EAST 5TH STREET, PORT ANGELES, WA 98362
.n.1:Il-'.L.L\".:a.....LUll L'\IWlLUer
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr, name
Application description
Subdivision Name
Property Zoning . . .
Application valuation
Uj-00000572 Date 8/20/03
502 S LINCOLN ST
06-30-00-0-1-6700-0000-
SHELL STATION
1500
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SIGNS
Owner
Contractor
PETTIT,OIL COMPANY
820 MYRTLE ST
HOQUIAM WA 985504236
ADVERTISING SALES & MORE
1327 E. 1ST STREET
PORT ANGELES
PORT ANGELES WA 98362
(360) 452-7785
Permit
Additional desc
Sub Contractor
Permit Fee
Issue Date
Expiration Date
ELECTRICAL SIGN PERMITS
REPLACE 2 SIGNS
SIMPSON ELECTRIC
52.10 Plan Check Fee
8/20/03 Valuation
2/17/04
.00
1500
~
~
Qty Unit Charge Per
1.00 35.3000 ECH EL-COMM-1ST SIGN
1.00 16.8000 ECH EL-COMM-ADD SIGN
Extension
35.30
16.80
C"L
~\ CA
'~,
:; 11~
,Cj C::
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Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 52.10 52.10 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 52.10 52.10 .00 .00
~
Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days, if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not
presume to give authority to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
Signature of Contractor or Authorized Agent
Date
Signature of Owner (if owner is builder)
Date
T'\PLANNING\FORMS\1102 15 [412002]
BUILDING PERMIT INSPECTION RECORD
CALL 417-4815 FOR BUILDING INSPECTIONS. PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE. IT IS UNLA WFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED, POST PERMIT IN A CONSPICUOUS LOCATION.
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
( INSPEC;n.ON TYPE DATE ACCEPTED COMMENTS
.~ - - } I YES I NO
... '
FOUNDATION: ,--..'
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEP ARA TE PERMIT: #
ROUGH-IN I
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATER LINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T -BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engmeenng DIvisIOn) SEPARATE PERMIT #'s:
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA:
PARKING/LIGHTING ESA:
LANDSCAPING SHORELINE:
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRJCAL - LIGHT DEPT. 417-4735 ELECTRJCAL 8 bok ~ Ac/J
LIGHT DEPT
CONSTRUCTION R W / PW/ CONSTRUCTION - R W. I /
ENGINEERJNG 417-4807 PW / ENGINEERJNG
FIRE 417-4653 FIRE DEPT.
PLANNING DEPT 417-4750 PLANNING DEPT.
BUILDING 417-4815 BUILDING
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CITY OF PORT ANGELES
DEPARTMENT OF COMMUNITY DEVELOPMENT - BUILDING DIVISION
321 EAST 5TH STREET, PORT ANGELES, W A 98362
Application Number
Property Address
ASSESSOR PARCEL NUMBER:
Tenant nbr. name
Application description
Subdivision Name
Property Zoning . . .
Application valu~tion
03-00000572 Date 6/12/03
502 S LINCOLN ST
06-30-00-0-1-6700-0000-
SHELL STATION
SIGNS
1500
Owner
Contractor
PETTIT OIL COMPANY
820 MYRTLE ST
HOQUIAM WA 985504236
ADVERTISING SALES & MORE
1327 E. 1ST STREET
PORT ANGELES
PORT ANGELES WA 98362
(360) 452-7785
Permit
Additional desc
Permit Fee
Issue Date
Expiration Date
SIGN
145.00
6/12/03
12/09/03
Plan Check Fee
Valuation
.00
1500
er,
C)
<fS
Qty Unit Charge Per
1.00 30.0000 PER S- SIGN LES THAN 25 SF
1.00 115.0000 PER S- SIGN FREE OR PROJ 25+
Extension
30.00
115.00
Fee sununary Charged Paid Credited Due
----------------- ---------- ---------- ---------- ----------
Permit Fee Total 145.00 145.00 .00 .00
Plan Check Total .00 .00 .00 .00
Grand Total 145.00 145.00 .00 .00
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Separate Permits are required for electrical work, SEPA, Shoreline, ESA, utilities, private and public improvements. This permit becomes
null and void if work or construction authorized is not commenced within 180 days. if construction or work is suspended or abandoned
for a period of 180 days after the work as commenced, or if required inspections have not been requested within 180 days from the last
inspection I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of
laws and ordinances governing this type of work Will be complied with whether specified herein or not. The granting of a permit does not
presume to give authOrity to violate or cancel the provisions of any state or local law regulating construction or the performance of
construction.
~-
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1'2 _ .0'3.
Date
Signature of Owner (If owner is builder)
Date
Signature of Contractor or Authorized Agent
T \PLANNING\FORMS\J 102 15 [4/2002J
BillLDING PERMIT INSPECTION RECORD
\
\
.~
CALL 417-4815 FOR BUILDING INSPECTIONS PLEASE PROVIDE A MINIMUM 24 HOUR NOTICE IT IS UNLAWFUL TO COVER,
INSULATE OR CONCEAL ANY WORK BEFORE INSPECTED AND ACCEPTED. POST PERMIT IN A CONSPICUOUS LOCATION
KEEP PERMIT CARD AND APPROVED PLANS AT JOB SITE
INSPECTION TYPE DATE I ACCEPTED COMMENTS
YES NO
FOUNDATION:
FOOTINGS
WALLS
FOUNDATION DRAINAGE
ELECTRICAL (LIGHT DEPT) SEP ARA TE PERMIT #
ROUGH-IN
PLUMBING
UNDER FLOOR / SLAB
ROUGH-IN
WATERLINE
GAS LINE
BACK FLOW / WATER
AIR SEAL
WALLS
CEILING
FRAMING
JOISTS / GIRDERS
SHEAR WALL
WALLS / ROOF / CEILING
DRYWALL
T-BAR
INSULATION
SLAB
WALL / FLOOR / CEILING
MECHANICAL
HEAT PUMP
WOOD STOVE / PELLET / CHIMNEY
HOOD / DUCTS
PW UTILITIES / SITE WORK (Engmeenng DIVISIOn) SEPARATE PERMIT #'s'
WATERLINE / METER
SEWER CONNECTION
SANITARY
STORM
PLANNING DEPT. SEPARATE PERMIT #'s SEPA
PARKING/LIGHTING ESA
LANDSCAPING SHORELINE
FINAL INSPECTIONS REQUIRED PRIOR TO OCCUPANCY/USE
RESIDENTIAL DATE YES NO COMMERCIAL DATE ACCEPTED
YES NO
ELECTRICAL - LIGHT DEPT. 417-4735 ELECTRICAL
LIGHT DEPT
CONSTRUCTION R W / PW/ CONSTRUCTION - R W
ENGINEERING 417-4807 PW / ENGINEERING
FIRE 417-4653 FIRE DEPT
PLANNING DEPT 417-4750 PLANNING DEPT
BUILDING 417-4815 I '{' - '" .-0." J,L BUILDING
T \PLANNING\FORMS\II02 IS [4/2002]
CITY OF PORT ANGELES
DEPARTMENT OF PUBLIC WORKS
. . . . . . . . . . . INSPECTION REPORT. . . . . . . . . . .
REQUEST:
Date @-t~-D3
.~
\
Time
Received by
RV
Lv .\~\.~o J.,
...
(phone, person)
Location of Work to be inspected ~D2- "'~')
Name of person requesting inspection
Address of person requesting inspection
Type of I (circle appropriate one):
Sew ing Chimney Plumbing Final Sewer Excav. Other
Phone No.
Permit No.
S-7 '2-
..
Inspected: Date
Remarks:
Time~1V[
By
JC"
RESTORATION REQUIRED . . . . .. YES NO
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SURFACE RESTORATION:
SURFACE TYPE: 0 Unimproved 0 Gravel 0 Asphalt 0 PCC
o Other
o Repaired by City
o Repaired by Permittee
o No Damage Found
Work Order #
o COMPLETE
o INCOMPLETE
(Continue on reverse side if necessary)
STREET SUPERINTENDENT
(DATE)
BUILDING PERMIT - APPLICATION
FOR OFFICIAL USE ONLY
Date RecS-Z7 -<::LJ
Penmt#" 57 Z.
Fill out COMPLETELY and in INK. Your application and site plan MUST BE
COMPLETE to be accepted for review. Uyou have any questions, call
(360) 417-4815
Date Approved
Date Issued
Applicant J5 Agent:
Owner: Vc6?'""l'( t '7
A S ~l So \..~~
0,__ Co.
M'-t~7L6 9t-:
t\ s;: --l ~ \.C....J r }
,
S' l C~ S State LIcense #:
Phone:
Y-~'2 - 1'1 R-S'"
Phone:
Address: X' 2. (;)
City: 11,:)&0 i ~r""'
ZIp:
'1 a-S; s;: 0
ArchitectJEngmeer:
Contractor A-~ 1'..-'\.
2- I _....... ~:2.Q..~ Phone:
/'"
()"...{ hc.c<- Exp:
Phone:
Address:
PROJECT ADDRESS: S" 0 1l: ~ -,,..
LEGAL DESCRIPTION: Lot: I d- 2
City:
~ I....J G.:::o ~ cJ
Block: I b "(
ZIp:
ZONING:
c..SD
SubdivlSlon:
CLALLAM COUNTY PARCEL NUMBER: 0 b ~ 000 C> I ~ l 0 0
Credit Card Holder Name:
Billing Address: City:
Credit CardType VISA MC # Exp. Date:
TYPE OF WORK: .. J~LUATION:
o ResIdential 0 New Constr. 0 Re-roof 0 Stove ((-/5 "SF. @ $ /SF. = $
o Multi-family 0 AddItIOn 0 Move 0 Garage '/ - SF. @ $ /SF. = $
o CommercIal 0 Remodel 0 DemohtIOn 0 Deck SF. @ $ /SF. = $
o Repair ;a: SIgn 0 Other TOTAL VALUATION $ J ~oo. (90
BRIEF DESCRIPTION OF THE PROJECT: X<.~S"""t.o-,-<- -0"'-' ~ ~\.::::. ,ctt.&eS-'"\~r.::.(N Q..
8lOs.......) ~ o~ c<; c..ClN o4?'-( <b. lG..j
COMMERCIAL/RESIDENTIAL: Occupancy Group:
Occupant Load:
ConstructIOn Type'
No. of Stones: Lot SIze: EXIstmg Sq. Ft. & Proposed Sq Ft.
Existmg lot coverage _ % & Proposed lot coverage _% = Total lot coverage ~~
APPROVALS:
PLAN qfIJ/o z,
BLDG:
DPWU:
FIRE:
OTHER:_
BUILDING PERMIT APPLICA TION SUBMITTAL: The BUIldmg DIVISIOn can provIde you WIth mformatIOn on the apphcatlon and
plan subnnttal reqUIrements If you have questIOns.
VALUATION OF CONSTRUCTION: In all cases, a valuation amount must be entered by the applIcant. ThIS figure WIll be reVIewed
and may be reVIsed by the Buildmg DIVISIOn to comply WIth current fee schedules. Contact the Perrrnt Coordmator at 417-4815 for aSSIstance
PLAN CHECK FEE: IF a plan check fee IS due It must be subnntted at the tIme the bUIldmg perrrnt apphcation and constructIOn plans are
submitted. All other perrrnt fees are due at the time of perrrnt Issuance.
EXPIRATION OF PLAN REVIEW: If no perrrnt IS Issued withm 180 days of the date ofapphcation, the application will expire. The
Buildmg OffiCIal can extend the time for action by the applIcant up to 180 days upon wntten request by the apphcant (see Section 1074 of
the Umform BuIlding Code, current edItion). No apphcation can be extended more than once.
.
I hereby certify that I have read and exammed this application and know the same to be true and correct I am authorized to apply for thiS pemllt and
understand that it is my responslblltty to determme what penmts are reqUired ,not the . , st obtain such permits pnor to work
T \FORMS\APPS\BUlldmgpermlt wpd
Apphcant:
Date: ~. 2 L - 0 ~
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CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
PERMIT NO.
1/?f/9'
// /z/pt/
I "
DATE
ELECTRICAL PERMIT
Installed By:
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Site Address:
Owner/Business:
Phone:
Owner/Business Address:
Sq. Ft.
ELECTRIC HEAT
o BASEBOARD KW _
o FURNACE KW _
o HEAT PUMP KW
o FAN/WALL KW _
o RESIDENTIAL
o COMMERCIAL
o NEW CONSTRUCTION
o REMODEL
~ ADD/ALTER CIRCUITS
tJ SERVICE UPGRADE/REPAIR
o TEMPORARY SERVICE
o RISER
o OVERHEAD SERVICE
o UNDERGROUND SERVICE
VOLTAGE:
0116 0316
SERVICE SIZE
FEEDER SIZE
AMPS
AMPS
DetailslDescription:
/V;:ti 2k~^:~::;!-w/'
.
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. 0 NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
ENGR.
o OVERHEAD SERVICE APPROVED
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
o O.K. to connect service
-1M """ Final O.K.
Installer:
permit'rlp>
New Meters ____
.
Notify Port Angeles City Light by Street Address and Permit Numberwhen ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Building Permit. PHONE 457-0411, EXT. 224. "p
T ~ NO OCCUPANCY OR USE ESTABLISHED UNDEA THIS PERMIT $ .r c::2..5'
Electrical Inspector
Permit Fee
WHITE - File by address
PINK - Top: Eng, Bottom, Customer
GREEN - Top: Meter Dept" Saltorn: City Hall
OLYMPIC PRINTERS INC.
.
CITY OF PORT ANGELES LIGHT DEPARTMENT
321 E. Fifth Street
Port Angeles, WA 98362
(206) 457-0411
ELECTRICAL PERMIT
Site Address:
Installed By:
Owner/Business:
Owner/Business Address:
o RESIDENTIAL
o COMMERCIAL
o BASEBOARD KW _
o FURNACE KW
o FAN/WALL KW
o HEAT PUMP KW
o SIGN
o TEMPORARY SERVICE
o PERMANENT SERVICE
o NEW CONSTRUCTION
o REMODEL
o ADD/ALTER CIRCUITS
o SERVICE UPGRADE/REPAIR
i)!l SPECIAL EQUIPMENT
(LIST BELOW)
Details/Description:
PERMIT NO. ~.:J (3
/o//s-n .3
( ,
DATE
o READY FOR
INSPECTION
License Number:
o WILL CALL FOR
INSPECTION
Phone:
Phone:
Sq. Ft.
o OVERHEAD SERVICE
o UNDERGROUND SERVICE
VOLTAGE:
o SINGLE PHASE
o THREE PHASE
SERVICE SIZE AMPS
.
.~~
cI~~<J
W.S. No. SERVICE SIZE
CAPACITY:
o O.K. NOT O.K.
ACTION REQUIRED: 0 CHANGE TRANSFORMER
o INSTALL SERVICE POLE
DATE
\
7
ENGR.
o CHANGE SERVICE WIRE
o OTHER
o Ditch Inspection O.K.
o Rough-in/cover O.K.
j _ 0 O.K. to connect service
/()A"f. Final O.K.
Site Address:
SoD?.- ~l,
I
Installer:
New Meters
Notify Port Ang es Cit Light by Street Address and Permit Number when ready for inspection. Work must not be covered
before inspection and O.K. for covering has been given by the electrical inspector in writing on either the Wiring Report
or on the Buildi]1g.Permit. PHONE 457-0411, EXT. 224. M
~ ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT $ .3. D
Electrical Inspector Permit Fee
I.
WHITE - File by address
YELLOW - file by number
PINK - Top: Eng, Bottom, Customer
OLYMP:C PRINTERS INC.
GREEN - Top: Meier Dept., Bottom: City Hall
Installed By:
CITY OF PORT ANGELES
LIGHT DEPARTMENT
..
ELECTRICAL PERMIT
PERMIT NO. C3037
$1'-9' -~/
DATE
Site Address:
o READY FOR 0 WILL CALL FOR
INSPECTION INSPECTION
License Number: Phone:
OwnerfBusiness:
Phone:
Owner/Business Address:
Sq. Ft.
o Residential
Heat KW
o Baseboard 0 Furnace/Boiler
o Heatpump 0 Other
?,commercial/lndustrial load
Total Connected load
(attach breakdown)
Total Motor load
(attach breakdown)
o New Construction
o Remodel
o Service update/alter/repair
)o("Overhead
o Underground
Voltage
010 03.0
Service size
o Temporary
t:t Add/alter circuits
o Auxiliary power
(list below)
o Special equipment
(list below)
Amps
Detai IslDescription:
.
FAM ae.qw./
/
.
firMt~ ~ ,.r'
S- h:~' /J /P'
fi/c/
'!(W/IRF
W.S. No. Service Size
Capacity: 0 O.K. 0 Not O.K. Comments
o Ditch inspection O.K.
o Rough-in/cover O.K.
o O.K. to connect service
c~.:f Final O.K.
Date
Hold for: 0 Easement 0 Letter
o Signed up for service/meter
o Meter Department notified for installation
o Fire Department notified of inspection
o Plan Review approved/pending
.
SiteAdd~ J L,'nCf)1v
Installe/J1 C--~ oj;
Notify the Department of City Light by Street Address and Permit Number when ready for inspection. Work
must not be covered or electrically energized before inspection and O.K. for covering or service has been given
by the Inspe~riting on the Wiring Report or the Building Permit. PHONE 457-0411, EXT.158 or EXT. 224.
(' I ~ NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT d:2c::2 <;!O
'Inspector Amount paid
WHITE - file by address YELLOW - file by number PINK - Top: Eng, Bottom: Customer GREEN - Top: Inspector, Bottom: City Hall
Permit/Receipt No.
oJ1
New Meters Date:
-'1--9/
OLYMPIC PRINTERS. INC.
~~~~UMBER
CITY OF PORT ANGELES
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
/;;S /
PERMIT NUMBER
.
TOTAL FEE /t.~
co NT. Lie. NO. TIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
Site Address
NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
Owner
PERMITS WITH WRONG AD
Installation By
o
o
A
wner's Address r Installers Address ~ . /
ay Phone Installers Phone '/'/tJ.<.lll /f///J1en/ij
PPIIC~~S hereby made for P:,<~ to i:jt; eetrical E'JUlpment as ~~OWS: . /
'/J -- ^ . 0 Vvt-' 't; jZ" ~. /VI ve: f/'oitl {JJvr(Ict.Y
A-ul 71;: -- ~ .i}/s PC"1..dWn' <""..2. ../ h. ~iring Method ~ ~t" .
.
( U ,
AMP 12QV [ - 240V NUMBER AMP 120V 24QV
USE OF CIRCUIT NUMBER PER' 100A FEE USE OF CIRCUIT PER 100R FEE
CIRCUITS CIR 10 30 CIRCUITS CIR . 10 30
LIGHT SIGN
LIGHT 50 VOLTS
OR LESS
CONVENIENCE MOTOR
CONVENIENCE MOTOR
APPLIANCE MOTOR
DISHWASHER . FIRE ALARMS
DISPCSAL BURGLAR ALARM
RANGE MISC.
OVEN
WATER HEATER
LAUNDRY -c-
DRYER REINSTALLATION LIGHT FIXTURE #
FURNACE SUB TOTAL FEE
GAS. OIL
FURNACE ENERGY FEE
ELECTRIC - BASIC FEE
ElECTRIC HEAT
TOTAL FEE
ElECTHIC HEAT SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
A.C. U~llT AMP PHASE
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE AW.G.
I SUB-TOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH
.
I certify that the work to be performed under this permit Will, be do~e b,Y the installer and in conformanc~ With~E.C, Electrical Code.
Date Application made ,19 By 7); ,/t1'~
CONTRACTOR OR OWNER (OR AUTHORIZED AGENT)
Permission is hereby given, to_do the above described work, according to the conditions hereon and according to the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances of the City of Port Angeles.
~ ~. f7 By DIRE OR OF CITY LIGHT
I ~ 'I d PLANS APPROVED
.
Date Permit Issued
WARNING
Notify Department of City Light by Street Address and P rmit Number when ready for inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in
Writing on Permit Placard. A, - Permits Phone: 457-0411 Ext.158.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
WHITE, Original CANARY, Dupiicate PINK. Triplicate WHITE CARD. Inspector's Report
OLYMPIC PRINTERS, INC.
DATE OF VISIT
j .
Jl..7117.f7
j
MADE BY
.
7~
REPORT OF INSPECTOR
\'
--
REMARKS
.
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O.K. FOR COVERING
O.K. TO CONNECT SERVICE
FINAL O.K.
.
11fV
CITYC?F PORT A.NGELE~
DEPARTMENT OF LIGHT
APPLICATION AND ELECTRICAL PERMIT
A
/075
PERMIT NUMBER
FEE RECEIPT NUMBER
.
.
)C, C'O Lt!J /11 ;VI ..
,TOTAL FEE - ..
CaNT. Lie. NO. TIME TO COMPLETE NO. STORIES LEGAL OCCUPANCY
-
Site Address. 5 D /-..;
Owner _0 ('. rm y S
Owner's Address
ELECTRICAL PERMIT ONLY NO OCCUPANCY OR USE ESTABLISHED UNDER THIS PERMIT
,)0. ) I~r.nl~
CORRECT ADDRESS 1$ RESPONSIBILITY OF APPLICANT
Te~ t11',n
PERMITS WITH WRONG ADDRESSES ARE CANCELLED
I'nstallation By i5 i'YtE:. Cove-
lIistallers Address .L1 () z- I-l 61, ~"nl1'11'!
. Installers Phone S'lL 38'1-/....,
CfB'ID2...
Day Phone
Application is hereby mad~Jor Permit to install Elect~!cal Equipmen.t.a.s -'allows:
TUI-.f)tN
31> (S !r""SY'1
f4^1 [
V,.."T
A-AJO
/1.-00
O/V'i..
bCAJ
A-r
fCf'-(ir.ftA-<...
W.iring ~et~.od
..
NUMBER AMP 120V 240V NUMBER AMP 120V 240V
USE OF CIRCUIT' CIRCUITS PER 10 100R FEE USE OF CIRCUIT CIRCUITS PER 10 100R FEE
CIR 30 CIR 30
LIGHT SIGN
LIGHT . . 50 VOLTS ,.
OR LESS
CONVENIENCE '. MOTOR
CONVENIENCE -' MOTOR
APPLIANCE . ... .. MOTOR ..
,
DISHWASHER . . FIRE; ALARMS -
DISPOSAL I BURGLAR ALARM
RANGE IJt 1-::> MISC.
OVEN [,AVt // 1/
WATEA HEATER '/ ./
/
LAUNDRY / .
DRYER ' , REINSTALLATION L1GH~ FIXTURE #
FURNACE - . SUB TOT ~L FEE
GAS - OIL
FURNACE ENERGY FEE
ELECTRIC - . BASIC FEE
ELECTRIC HEAT -
TOTAL FEE
ELECTRIC HEAT .SIZE OF SERVICE SWITCH OR CIRCUIT BREAKER
-
A.C. UNIT AMP PHASE. .
FEEDER SIZE OF SERVICE ENTRANCE CONDUCTORS
SERVICE AW.G.
I SUB-TOTAL SIZE OF GROUND SIZE OF ENTRANCE SWITCH
I certify that the work to be performed under this permit will be done by the installer and In'conformance with the N.E.C. Electrical Code.'
Date Application made
,19
By
CONTRACTOA OR OWNER (OR AUTHORIZED AGENT)
~ermis.sion is here~y.gi.ven to do the above described work, according to the co ~i_tlons hereon and according to.the approved plans and
specifications pertaining thereto, subject to compliance with the Ordinances t e City of P tt An
01 eTO Y. LIGHT
WARNING
Notify Department of City Light by Street Addr~ss and Permit Number when ready for Inspection. Work must not
be covered or current turned on before inspection and O.K. for covering or service has been given by Inspector in
. Writing on Permit"Placard. A."o Permits Phone: 457-0411 Ext.-158: "0.
PERMIT PLACARD MUST BE KEPT POSTED ON THE WORK - SEE OVER -
.
Date Permit Issued
WHITE. Original CANARY. Duplicate PINK 0 Triplicate WHITE CARD. Inspector's Report
OLYMPIC PRINTERS.INC"
r.
'.
REPORT OF INSPECTOR
f' j',
DATE OF VISIT MADE BY REMARKS
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08/03/2003 22:08
4579270
SIMPSON ELECTRIC
PAGE 01
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ELECTRICAL PERMIT APPLICATION
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Th. Elootrlool Po",," Applle.'lon must lis llilod O1It QDmDlotely,
PI.....l\Ip. or 'optlnt In Ink. "you M" any q...aUDn", pl..... ..11 (3DD. 41'r-47~~
/I "S' F.. numl>llr: (3S0) 4174711 ~ 'I' 0-1 o-lt.
fVORE I" '''''PSCfY1
Owne, or 101.0. Contraoto, Ag.nt:Sit!:l-f~ccktr::_ PMn.: tj 51~ F.,.: ...~
Pnope~Own.r: ?t()Lt{.~_Si:u:J.J_-
Add"'." Z-r;fj#. ,. H/yQ,oltf S-tred- CIIy: P II. _._...__.___._z;p:_tjj;-1l.~
eleotrla"1 Controetor: ~,. '!}j?~~[;~ tlcano. #:~'Wdf.... exp: .""._.!2~__"_...f'rlnl).:_~___._,,.
Addr...:~ 301 lJw-& /01 Lv, CIty:.J2. fJ.. _.___._.._......_1.lp: .f.fd63 ".
INST AU-A nON WIRED BV: 0 OWNER 0 EI.EOTAICAl OONTRACTOR
-# 57::2.
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Crlldlt CSrd Holder Name:
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fill/Ins Address:
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Clly:_
Credit Card Number:
.--...-.--.--_ Exp. Oete.
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TYPl!! OF WORJs.: Check.ii.!J ~hlilt apply: ~ New 0 Allarellon/Addltlon
o Reslclentel 0 Multi-family rj. Commercial [I Mobile Home Sq. H_...__..._..__,..
o Remote Meter 0 Deta.ched garage 0 Hot Tub 0 Swim Pool 0 Seprlc Pump 0 I.ow '/allage 0 YOllleoom. )i(B1fJ'"
Numb.r 01 Clroulta added Dr altererJ: __".~
DESCRIPTION OF THE ELECTRICAl. f''RO,'ECT:__-.1Le fJ Jete" l nj :J. "Sl!JdS..___..._"._.___..
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JiJ..e!rtrlc:lIIl Hellt Load Addlll!ml1
$>t{:1 <;Ii;
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VQilag~: ..1;!,Q"..JIf) 11-
Phoe.e: Cl1 [] 3
ServIce ~:OL;)~~ _.__,_..,~_.,
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o Ilaseboard
o F~rnacG
iJ Heat Pump
[] Fan"Wall
_KW
--KW
-KW
-KW
o Overhead Servlca
D Temp Bervloa
o Undllrgrounci Service
PAMC 14,05.060(B): For IndualMI, commercial, & r"sld.nllel projecte Isrger thsn a duplex, e one" line r.I:'/;!w1nQ 0' lI'Ill "'Ieetrlce! SelVie.. &.
Feedsrs, bUilding ilzs (sq, ft.), loed C&lcuII'l11ons, and Ille Iypa 8. of oonductors end/or raoeway 10 required "'nd r.h~1I aCCOmpany the
F.loctrlcal Permll application,
I hereby cenlfy that I have read and examln4ild this application and know that Blilmo to ho trUE! end correct, and I am
authorized to apply for tills permIt. I understand It Is not the City's legal responsibility to dMerrn/ll/3 what permits
are required; it remslns till:! applicfmts responsibility to determine what permitB fire req[/i~d and to obtain such.
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